TY - JOUR
T1 - Understanding upper limb recovery after stroke
AU - Buma, F.
AU - Kwakkel, G.
AU - Ramsey, N.
PY - 2013
Y1 - 2013
N2 - This review addresses what is currently known about the time course of skill reacquisition after stroke. There is growing evidence that the natural logarithmic pattern of functional recovery can be modified by intensive task-oriented practice preferably initiated within 6 months after stroke. However, the impact of practice on the learning-dependent and intrinsic spontaneous mechanisms of neurological recovery is poorly understood. At least four probably interrelated mechanisms have been identified that drive motor and recovery after stroke: (1) salvation of penumbral tissue in the first days to weeks after stroke; (2) alleviation of diaschisis; (3) homeostatic and learning-dependent (Hebbian) neuroplasticity; (4) behavioral compensation strategies. These mechanisms underlying recovery are highly interactive, and operate in different, sometimes limited, time-windows after stroke onset. In line with these mechanisms of improvement after stroke, we present a hypothetical phenomenological model for understanding skill reacquisition after stroke. Translational research is important at this point to improve our knowledge about the neural correlates of what and how patients learn when they show functional improvement after stroke. This knowledge should serve as a basis to optimize the timing, focus and intensity of evidence-based rehabilitation interventions and to design innovative strategies to enhance motor recovery after stroke. © 2013-IOS Press and the authors.
AB - This review addresses what is currently known about the time course of skill reacquisition after stroke. There is growing evidence that the natural logarithmic pattern of functional recovery can be modified by intensive task-oriented practice preferably initiated within 6 months after stroke. However, the impact of practice on the learning-dependent and intrinsic spontaneous mechanisms of neurological recovery is poorly understood. At least four probably interrelated mechanisms have been identified that drive motor and recovery after stroke: (1) salvation of penumbral tissue in the first days to weeks after stroke; (2) alleviation of diaschisis; (3) homeostatic and learning-dependent (Hebbian) neuroplasticity; (4) behavioral compensation strategies. These mechanisms underlying recovery are highly interactive, and operate in different, sometimes limited, time-windows after stroke onset. In line with these mechanisms of improvement after stroke, we present a hypothetical phenomenological model for understanding skill reacquisition after stroke. Translational research is important at this point to improve our knowledge about the neural correlates of what and how patients learn when they show functional improvement after stroke. This knowledge should serve as a basis to optimize the timing, focus and intensity of evidence-based rehabilitation interventions and to design innovative strategies to enhance motor recovery after stroke. © 2013-IOS Press and the authors.
U2 - https://doi.org/10.3233/RNN-130332
DO - https://doi.org/10.3233/RNN-130332
M3 - Article
C2 - 23963341
SN - 0922-6028
VL - 31
SP - 707
EP - 722
JO - Restorative neurology and neuroscience
JF - Restorative neurology and neuroscience
IS - 6
ER -